Public opinion survey after capsule endoscopy: patient's point of view on its utility

AIM

When programming a medical test such as capsule endoscopy (CE), finding the closest point between the patient's experience and his/her expectation is essential to improve any further explorations. For this purpose we designed a form which tries to collect the information required.

MATERIAL AND METHODS

From December 2003 to January 2005 we examined the small intestine of 98 patients with the help of CE. Later they were sent an anonymous questionnaire in July 2005, which included 10 questions upon the origin and previous knowledge of the patient about this technique, their tolerance to it, and the value they attached to it with regard to finding a new diagnosis and assigning different treatments, and also the incidence in the positive or negative evolution of their disease in particular and of medicine in general.

RESULTS

Answer rate reached 58% and was slightly higher among women and people over 70 years; 80% of repliers had been informed about CE by a physician, while nearly all the rest had received previous information from the media; 37% had had symptoms for more than 12 months, while only 17% had suffered them for one month before the exploration. A bit over 30% did not know what the specific diagnostic field of the test was (most of them women and young people), although most of them were not surprised by the procedure. Over 75% showed "acceptable" or "excellent" tolerance, while 5.5% (most of them young people) found it hard to bear. The opinion about its utility in the diagnosis was 37%, and although 70% thought that CE had revealed nothing new about their pathology, over 60% declared feeling better after the test; 84% pointed out that it had achieved a breakthrough for their quality of life (most of them men and very old people), and only 13% thought it was worthless. However, nearly all the answers agreed in that CE was an "important" or "very important" diagnostic device.

CONCLUSIONS

After the test using CE, the diagnostic benefit detected by the patient is not the same as that shown by technical studies. Nevertheless, the test can be highly satisfactory for the patient in particular, and also in an overall view. CE is a well-tolerated test, applied in our setting to chronic diseases and that, contrary to what we supposed, is explained to patients mainly by a physician. Most of them are not familiar with its specific indications.

[Dietary intake of a group of patients with irritable bowel syndrome; relation between dietary fiber and symptoms]

OBJECTIVES

The aim of our study was to evaluate the oral dietary intake of a group of patients with irritable bowel syndrome and to compare with international recommendations.

PATIENTS AND METHODS

A total of 53 patients with irritable bowel syndrome was enrolled in a non-propabilistic sample. Patients were diagnose with Roma II criteria. In all patients were determined, weight, height, body mass index, dietary intake of 3 days and a symptoms scoring system.

RESULTS

The average age of 53 patients was 45.67+/-13.6 years with a distribution of sex (22 males/31 females). Caloric intakes was right in absolute terms and corrected by weight. Distribution of calories was 41.5% of carbohydrates, a 19.8% of proteins, and a 38.7% of lipids, showing a high intake of lipids and low of carbohydrates. A low intake of vitamin A and D was detected. High intake of vitamin B12, vitamin C and niacine was observed. A low intake of calcium, magnesium, yodo and zinc was detected. Intake of soluble fiber was lower than insoluble fiber (1.46+/-0.74 g/day) (19%) vs 6.21+/-2.67 g/day (71%). Intake of fiber corrected by calories was low 4.5+/-1.2 g/1000 calories. In correlation analysis, insoluble fiber (r=0.46; p < 0.05) and soluble fiber (r=0.42; p < 0.05) were inverse correlated with general symptoms.

CONCLUSIONS

Patients with irritable bowel syndrome showed a deviation of mineral and vitamin dietary. Fiber intake is low, a correlation between fiber intake and general symptoms was detected.

[Effects of oxytetracycline on rat liver]

OBJECTIVES

This experimental project was designed to evaluate: a) the capacity of oxytetracycline to induce microvesicle steatosis in rat liver when administered over long time periods; b) whether female rats are more susceptible to this substance, and c) the possible ultrastructural alterations and their relation to the mechanisms of steatosis.

METHODS

Sixty-two Wistar rats (31 males and 31 females) were distributed into six groups, two control groups and four experimental groups. The experiment lasted three months. Blood and hepatic tissue samples were extracted under anesthesia for morphologic study (optical and electron microscopy).

RESULTS

Steatosis was of the microvesicular type with mainly periportal distribution. Steatosis developed in the treated groups and the degree was significantly greater in the females (p = 0.004). No relationship was found with dose. Ultrastructural study revealed microsome dilation in all experimental groups, with no differences according to sex. Despite the steatosis, no proliferation of peroxisomes or mitochondrial alterations were observed.

CONCLUSIONS

Oxytetracycline produced predominantly periportal microvesicular hepatic steatosis, appearing mostly in the females. As a possible mechanism for tetracycline-induced steatosis, we postulate a decrease in mitochondrial, peroxisome and microsome function as a result of protein synthesis inhibition in these cell compartments.

[Anti-ulcer drug consumption in Spain]

OBJECTIVE

To check whether therapy to eradicate Helicobacter pylori has succeeded in reducing the consumption of traditional ulcer medication.

DESIGN

A longitudinal, retrospective study of the use of medication.

SETTING

Spain in the decade from 1988 to 1997.

PARTICIPANTS

Pharmaceutical products belonging to the anatomical therapeutic group AO2B (for ulcers) and dispensed at the Social Security's expense.

MEASUREMENTS AND MAIN RESULTS

Despite the widespread use of treatments to eradicate H. pylori, it was found that consumption of ulcer medication continued to increase markedly, from 5 daily doses per 1000 inhabitants in 1988 to 19 in 1997. In 1997 the two most frequently taken active principles in the group were omeprazole and ranitidine. Drugs indicated for gastric protection were also used much more. However, in absolute values, they stayed well below anti-H2 drugs and proton pump inhibitors.

CONCLUSION

The introduction into Spain of therapy to eradicate H. pylori has failed to reduce the use of ulcer medication. The use of anti-H2 drugs and proton pump inhibitors for gastric protection may explain a part of the increase in consumption experienced by these two pharmacological groups.